机械通气 ICU 患者的多部位去污：一项真实研究。

Multiple-site decontamination in mechanically ventilated ICU patients: A real-life study.

机构信息

Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust 22000 Saint-Brieuc, France.

Service de Microbiologie, CH de St BRIEUC, 10, rue marcel Proust 22000 Saint-Brieuc, France.

出版信息

Infect Dis Now. 2023 Apr;53(3):104666. doi: 10.1016/j.idnow.2023.104666. Epub 2023 Feb 2.

DOI:10.1016/j.idnow.2023.104666

PMID:36736667

Abstract

INTRODUCTION

Decontamination regimen decreases acquired infection (ICU-AI) incidence but has remained controversial, mostly because it contains a course of intravenous antibiotic. Multiple-site decontamination (MSD), which does not include systemic antibiotics, has been less widely studied but is associated with lower risks of ventilator-associated pneumonia (VAP), bloodstream infection (BSI) and multidrug resistant micro-organism (MDRO) acquisition. We aimed to confirm these favorable outcomes.

METHODS

A prospective pre/post-observational study was conducted in 5 ICUs in western France. Among them, 4 implemented MSD, whereas the fifth applied standard care (SC) throughout the study period. Patients who required intubation were eligible for study and divided into two groups: the MSD group if they were admitted to an ICU that already implemented MSD, or the SC group. The primary objective was to measure ICU-AI incidence.

RESULTS

Close to 1400 (1346) patients were available for analysis (334 in the MSD and 1012 patients in the SC group). In a multivariable Poisson regression model, MSD was independently associated with decreased incidence of ICU-AI (IRR = 0.33; 95 %CI [0.18-0.60] p < 0.001). Non-parsimonious propensity-score matching resulted in 334 patient-pairs with well-balanced baseline characteristics. There was a lower incidence of ICU-AI(6.3 % vs 20.7 % p < 0.001), VAP (3.6 % vs 16.2 % p < 0.001) and BSI (3.0 % vs 7.2 % p = 0.029) in the MSD group as compared with the SC group. Five (1.5 %) and 11 (3.3 %) patients respectively acquired MDRO (p = 0.206).

CONCLUSION

MSD is associated with decreased risk of ICU-AI, VAP and BSI, with no increase in MDRO acquisition.

摘要

介绍

去污方案可降低 ICU 获得性感染（ICU-AI）的发生率，但仍存在争议，主要是因为它包含一个疗程的静脉用抗生素。多部位去污（MSD）不包括全身抗生素，研究较少，但与呼吸机相关性肺炎（VAP）、血流感染（BSI）和多重耐药微生物（MDRO）的风险降低相关。我们旨在证实这些有利的结果。

方法

在法国西部的 5 个 ICU 进行了前瞻性前后观察性研究。其中 4 个实施了 MSD，而第 5 个在整个研究期间实施了标准护理（SC）。需要插管的患者符合研究条件，并分为两组：如果他们入住已经实施 MSD 的 ICU，则为 MSD 组，如果他们入住 SC 组。主要目的是测量 ICU-AI 的发生率。

结果

近 1400（1346）名患者可用于分析（MSD 组 334 名，SC 组 1012 名）。在多变量泊松回归模型中，MSD 与 ICU-AI 发生率降低独立相关（IRR=0.33；95%CI [0.18-0.60] p<0.001）。非简约倾向评分匹配产生了 334 对具有良好基线特征的患者对。MSD 组 ICU-AI（6.3% vs 20.7% p<0.001）、VAP（3.6% vs 16.2% p<0.001）和 BSI（3.0% vs 7.2% p=0.029）的发生率较低。MSD 组分别有 5（1.5%）和 11（3.3%）名患者获得 MDRO（p=0.206）。